Applying Comfort Theory to Improve Outcomes for People in Sickle Cell Crisis.

When people with sickle cell disease in vaso-occlusive crisis need hospitalization, they often experience fragmented and disparate treatment. Racial, gender, and socioeconomic treatment bias by providers, including nurses, is complicated by the current reactionary United States (US) controlled substance policies. To provide high-quality and respectful care, nurses can use Kolcaba's Comfort Theory as the framework for a holistic plan to assess, deliver individualized interventions, and evaluate outcomes for people experiencing vaso-occlusive crisis. Once in the electronic medical record, it can guide care during future hospitalizations. By refocusing on the nursing value of providing comfort care to individuals in distress, nurses can change treatment outcomes for clients.

Simple Method for Re-tightening IMF Wires without Breakage.

AIM: This clinical technique aims to retighten intermaxillary fixation (IMF) wires when loosened intra/postoperatively. BACKGROUND: Intermaxillary fixation is one of the most important steps to obtain stable and functional occlusion in maxillofacial trauma. However, IMF wires tend to loosen over time. This loosened wire is generally removed and a new wire is used for IMF. Removal and refixation is time-consuming for surgeon and unconformable for the patient. TECHNIQUE: We recommend a simple technique for re-tightening IMF wires without breakage, with the use of shepherd's crook explorer by making a small circular loop. CONCLUSION: This technique of re-tightening by looping further stretches and tightens the wire to regain stabilized occlusion with maximal intercuspation. CLINICAL SIGNIFICANCE: This technique eliminates the need for removal and refixation of IMF wires, thereby improving patient comfort, yet obtaining stable occlusion over a long period of time. How to cite this article: Madhu SK, Dominic S, Baptist J, et al. Simple Method for Re-tightening IMF Wires without Breakage. J Contemp Dent Pract 2024;25(3):289-291.

Tools used to assess comfort among patients undergoing high flow nasal cannula: A scoping review.

OBJECTIVE: The aims were twofold: (a) to map tools documented in the literature to evaluate comfort among patients undergoing high flow nasal cannula (HFNC) treatment; and (b) to assess if the retrieved tools have been validated for this purpose. METHODS: A scoping review, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR). In July 2023, PubMed, Scopus, CINAHL and Cochrane Library were consulted. Studies assessing comfort in adult, paediatric, and neonatal patients undergoing HFNC were included. RESULTS: Seventy-four articles were included, among which nine (12.2 %) investigated comfort as the primary aim. Twenty-five different tools were found, classifiable into 14 types, mostly unidimensional and originating from those measuring pain. The most widely used was the Visual Analogic Scale (n = 27, 35.6 %) followed by the Numerical Rating Scale (n = 11, 14.5 %) and less defined generic tools (n = 10, 13.2 %) with different metrics (e.g. 0-5, 0-10, 0-100). Only the General Comfort Questionnaire and the Comfort Scale were specifically validated for the assessment of comfort among adults and children, respectively. CONCLUSION: Although the comfort of patients undergoing HFNC is widely investigated in the literature, there is a scarcity of tools specifically validated in this field. Those used have been validated mainly to assess pain, suggesting the need to inform patients to prevent confusion while measuring comfort during HFNC and to develop more research in the field. IMPLICATIONS FOR CLINICAL PRACTICE: Comfort assessment is an important aspect of nursing care. Given the lack of validation studies in the field, efforts in research are recommended.

Effect of Music on Fatigue, Comfort, and Vital Signs in Patients After Liver Transplant Surgery: A Randomized Controlled Trial.

This randomized controlled clinical trial was conducted to determine the effect of music therapy on fatigue, comfort and vital signs of the liver transplant patients. The study sample comprised 120 adult patients (60 in the experimental and 60 in the control group) who met the inclusion criteria and agreed to participate in the study. In the experimental group, the researcher performed music therapy. After applying music therapy once to patients for 30 minutes, their fatigue, comfort, and vital signs were evaluated. No treatment was performed in the control group. According to music therapy follow-ups after liver transplantation, mean scores of fatigue levels were lower, comfort levels were higher, and vital signs were normal, with a statistical significance in the experimental group compared with the control group in all measurements before and after music therapy (P < .001). The study should be repeated using different parameters.

Does paracetamol improve quality of life, discomfort, pain and neuropsychiatric symptoms in persons with advanced dementia living in long-term care facilities? A randomised double-blind placebo-controlled crossover (Q-PID) trial.

BACKGROUND: The objectives of this study are to determine the effects of regularly scheduled administration of paracetamol (acetaminophen) on quality of life (QoL), discomfort, pain and neuropsychiatric symptoms of persons with dementia living in long-term care facilities (LTCFs). METHODS: A multicentre randomised double-blind placebo-controlled crossover trial for 13 weeks (January 2018 to June 2019) in 17 LTCFs across the west of the Netherlands. Inclusion criteria were age ≥ 65 years, (advanced) dementia and a moderate to low QoL, independent of the presence of pain (QUALIDEM ≤ 70). Exclusion criteria were the use of regular pain treatment, allergies to the study medication, severe liver disease, use of > 4 units of alcohol/day, weight < 50 kg and/or concomitant use of flucloxacillin. Participants received study medication (paracetamol/placebo) in two periods of 6 weeks each (1 week in between as a wash-out period). Randomisation decided in which order participants received paracetamol and placebo. Primary outcomes included QoL (QUALIDEM) and discomfort (DS-DAT), secondary outcomes included pain (MOBID-2) and neuropsychiatric symptoms (NPI-NH). RESULTS: Ninety-five LTCF residents (mean age 83.9 years [SD 7.6], 57.9% females) were included. Repeated linear mixed models showed no difference in mean differences of QUALIDEM (paracetamol +1.3 [95% CI -1.0-3.5], placebo +1.5 [95% CI -0.7-3.8]), DS-DAT (paracetamol -0.1 [95% CI -1.4-1.2], placebo 0.6 [95 CI -0.7-1.8]), MOBID-2 (paracetamol 0.0 [95% CI -0.5-0.5], placebo -0.2 [95% CI -0.7-0.3]) and NPI-NH (paracetamol +1.5 [95% CI -2.3-5.4], placebo -2.1 [95% CI -6.0-1.7]) in favour of either paracetamol or placebo. CONCLUSIONS: Compared to placebo, paracetamol showed no positive effect on QoL, discomfort, pain and neuropsychiatric symptoms in persons with advanced dementia with low QoL. It is important to find out more specifically which individual persons with advanced dementia could benefit from pain treatment with paracetamol, and for clinicians to acknowledge that a good assessment, monitoring and multidomain approach is vital for improving QoL in this vulnerable group. TRIAL REGISTRATION: Netherlands Trial Register NTR6766 . Trial registration date: 20 October 2017.

Risky Behavior: Hospital Transfers Associated with Early Mortality and Rates of Goals of Care Discussions.

INTRODUCTION: Inter-hospital transfer (IHT) patients have higher in-hospital mortality, higher healthcare costs, and worse outcomes compared to non-transferred patients. Goals of care (GoC) discussions prior to transfer are necessary in patients at high risk for decline to ensure that the intended outcome of transfer is goal concordant. However, the frequency of these discussions is not well understood. This study was intended to assess the prevalence of GoC discussions in IHT patients with early mortality, defined as death within 72 hours of transfer, and prevalence of primary diagnoses associated with in-hospital mortality. METHODS: This was a retrospective study of IHT patients aged 18 and older who died within 72 hours of transfer to Wake Forest Baptist Medical Center between October 1, 2016-October 2018. Documentation of GoC discussions within the electronic health record (EHR) prior to transfer was the primary outcome. We also assessed charts for primary diagnosis associated with in-hospital mortality, code status changes prior to death, in-hospital healthcare interventions, and frequency of palliative care consults. RESULTS: We included in this study a total of 298 patients, of whom only 10.1% had documented GoC discussion prior to transfer. Sepsis (29.9%), respiratory failure (28.2%), and cardiac arrest (27.5%) were the top three diagnoses associated with in-hospital mortality, and 73.2% of the patients transitioned to comfort measures prior to death. After transfer, 18.1% of patients had invasive procedures performed with 9.7% undergoing major surgery. Palliative care consultation occurred in only 4.4%. CONCLUSION: The majority (89.9%) of IHT patients with early mortality did not have GoC discussion documented within EHR prior to transfer, although most transitioned to comfort measures prior to their deaths, highlighting that additional work is needed in this area.

Use of subcutaneous fluids in palliative care with children: a case study.

Quality of life is a major consideration in children's palliative care, particularly at the end of life. Optimal symptom management is crucial in maintaining quality of life, with the aim being to ensure the child is as comfortable as possible. Ensuring adequate hydration will often be part of symptom management but may be associated with several practical and ethical challenges. Subcutaneous fluid administration in children's palliative care is relatively uncommon, so there is a lack of evidence on the topic. This article demonstrates that it is feasible to use subcutaneous fluid therapy in the children's hospice setting to address patients' hydration needs and manage their symptoms. It presents a case study of a child who received subcutaneous fluids in a children's hospice for dehydration and myoclonus. It uses the case study to discuss subcutaneous fluid therapy in the children's palliative care setting, including its indications and contraindications, administration, complications and important factors to consider.

Comfort of the child in intensive pediatric therapy: perception of nursing professionals.

OBJECTIVES: o analyze the concept of comfort in a Pediatric Intensive Care Unit from the perspective of nursing professionals. METHODS: descriptive research, with qualitative-quantitative approach, conducted in an Intensive Care Unit. Data collection occurred between January and May 2017; 40 nursing professionals participated in the study. The textual data obtained in the semi-structured interviews was processed in the Iramuteq 7.2 software. The Descending Hierarchical Classification and Bardin analysis were used for the discussion. Katharine Kolcaba's concepts were used as theoretical framework. RESULTS: three categories emerged: the environment that promotes (dis)comfort; feasible actions to promote comfort; uncomfortable actions in care. Final Considerations: it was possible to identify that comfort is offered by providing measures that favor the well-being, warmth, safety and tranquility of hospitalized children. The study brings a reflection about the nursing care provided to severely ill hospitalized children.

The Effect of Hand Massage Before Cataract Surgery on Patient Anxiety and Comfort: A Randomized Controlled Study.

PURPOSE: This study aimed to determine the effectiveness of hand massage on patient anxiety and comfort before cataract surgery. DESIGN: A randomized controlled trial. METHODS: The 140 patients in this study were assigned to the intervention group (n = 70), which received a 10-minute hand massage before cataract surgery, and to the control group (n = 70), which received routine nursing care. The visual analog scale (VAS) and Spielberger State-Trait Anxiety Inventory (STAI) were used to collect data. FINDINGS: The median STAI state scores of the intervention and control groups were found to be 46.0 (44.7 to 48.0) and 57.0 (55.75 to 59.00), respectively. The VAS comfort score of the intervention group after hand massage (4.0 [1.7-5.0]) was lower than that of the control group immediately before surgery (8.0 [6.0-10.0]) (P < .05). In addition, except oxygen saturation, the remaining vital signs were lower in the intervention group. CONCLUSIONS: Hand massage reduced the anxiety of patients, positively affected their vital signs, and increased their comfort.

Persons' Experiences of Suffering from Nephrotic Syndrome.

BACKGROUND: Little is known about health and wellbeing among patients with nephrotic syndrome (NS), despite it being a serious condition in patients with renal failure. In order to promote health, it is important that both healthcare professionals and patients are aware of the signs and symptoms of the disease. OBJECTIVES: The aim was to explore patients' experience of suffering from nephrotic syndrome. DESIGN: An inductive, qualitative method. PARTICIPANTS: Ten adult patients with either newly diagnosed or a relapse of NS treated in a University hospital, south of Sweden from February 2016 to February 2019. MEASUREMENTS: Data were collected using open-ended interviews and analysed by means of Lindseth and Norberg's phenomenological-hermeneutical method. RESULTS: Suffering from NS meant being a stranger in an unfamiliar world of symptoms, signs and medical treatment without professional guidance or piloting, illustrated by four themes: Feeling ill and well at the same time, Being passively adherent, Being in uncertainty, and Trying to comprehend and cope. IMPLICATIONS FOR PRACTICE: The result provides an in-depth understanding of the illness experience among patients with NS and constitutes a foundation for clinical guidelines on treatment, follow-up and health promotion. CONCLUSION: Patients with NS end up in a state of ambiguity due to a profound knowledge deficit that causes uncertainty and a lack of self-management. The experienced lack of professional self-management support is partly compensated for by social support from relatives, enabling those with NS to manage everyday life in a reasonable way.

Factors related to impaired comfort in chronic kidney disease patients on hemodialysis.

OBJECTIVE: to analyze the factors related to the impaired comfort of chronic kidney diseases (CKD) patients on hemodialysis. METHOD: this is a cross-sectional study with 80 patients undergoing hemodialysis in a renal replacement therapy unit through interviews using two instruments, one for clinical and sociodemographic characteristics and the General Comfort Questionnaire, during the hemodialysis session. Mann-Whitney tests and the logistic regression model were used for data analysis. RESULTS: the study found that being younger (p=0.045); being married (p=0.05); and absence of impaired physical mobility (p=0.007) were contributing factors for greater comfort in CKD patients on hemodialysis. Thus, when establishing the odds ratio, it was possible to observe that being 55 years of age or older, being single and having impaired physical mobility represents a 45.7% chance of developing this diagnosis. CONCLUSIONS: sociodemographic and clinical variables contribute to the study outcome, demanding attention during the planning of nursing interventions.

Use of 2 Types of Air-cell Mattresses for Pressure Ulcer Prevention and Comfort Among Patients With Advanced-stage Cancer Receiving Palliative Care: An Interventional Study.

Patients with advanced- or terminal-stage cancer and persons receiving palliative care are at high risk for pressure ulcers (PUs). PURPOSE: The purpose of this study was to examine the rate of PU development and levels of comfort of a dual-fit, air-cell mattress compared with an alternating, 2-layer overlay air-cell mattress in patients with advanced- or terminal-stage cancer receiving palliative care. METHODS: From January 2011 to December 2013, hospitalized patients with advanced- or terminal-stage cancer who were referred to a palliative care team, at least 20 years of age, able to communicate, experiencing pain, and did not have a PU were recruited to participate. Patients who consented were alternately placed on the intervention (dual-fit, air-cell) or control (2-layer air) mattress until hospital discharge or death. Demographic and clinical data, pain scores, performance status, Palliative Performance Scale scores, Braden Scale scores, tissue interface pressure, and comfort were assessed via interview using closed-end questions. If a PU developed, clinical characteristics were assessed using DESIGN-R. Descriptive statistics and the Mann-Whitney U, chi-squared, and Fisher's exact tests were used to analyze the data. RESULTS: Of the 123 eligible patients, 73 were randomized and 52 completed the study (23 intervention patients, median age 63 [range 27-80] years; and 29 control group patients, median age 61.0 [range 27-82] years). Mattresses were used a median of 17 (range 4-113) days in the intervention group and a median of 32 (range 3-270) days in the control group. The incidence of PUs did not significantly differ between the 2 groups (13% in the intervention and 17.2% in the control group). Interface pressures were significantly higher in the intervention group (27.0 mm Hg vs. 24.3 mm Hg). Comfort scores at rest were significantly better in the intervention than in the control group (sinking into bed [3 vs. 14, respectively]; slipping on bed [o vs. 16, respectively]; and feel pressure of air cell [2 vs. 14, respectively]), as were scores with movement (instability during movement [4 vs. 18, respectively] and feeling of floating of the buttocks [6 vs. 21, respectively]) (P <.05). CONCLUSION: Dual-fit, air-cell mattresses may help prevent PUs and improve comfort at rest and during activity among patients with end-stage cancer receiving palliative care. Further research regarding mattress selection protocols for this patient population is warranted.

Impact of skin-to-skin contact on maternal comfort in patients with elective caesarean section: A pilot study.

OBJECTIVE: Caesarean section is a well-known cause of difficulties in breastfeeding initiation. Mother-infant skin-to-skin contact allows to improve breastfeeding and maternal comfort but remains few practiced during caesarean section. Our objective was to evaluate maternal comfort before and after immediate skin-to-skin contact in case of elective caesarean section. METHODS: This was a prospective, observational, monocenter study including patients with elective caesarean section. Mother-infant skin-to-skin contact was begun immediately after birth. The Analgesia Nociception Index (ANI) is a well know heart rate variability (HRV) index, currently used in anesthesia, which decreases during painful stimulation and increases with maternal comfort. The Analgesia Nociception Index was compared before and after skin-to-skin contact. RESULTS: 53 patients were included. Skin-to-skin contact was started on average 4min (2-14, IIQ (3-5)) after birth. The median duration was 21min (4-40, IIQ (12.3-29.5)). It was interrupted in 24 patients: 9 from mother's wish, 11 for maternal reasons (drowsiness, stress, pain, maternal hypothermia, lipothymia, vertigo, nausea, cough) and 4 for the newborn (respiratory distress, low pH). The median Analgesia Nociception Index at the end of skin-to-skin contact and at the end of the intervention was statistically higher than that before skin-to-skin contact (p=0.034 and p<10-3 respectively). CONCLUSION: Skin-to-skin contact is possible during caesarean section and allows a better maternal comfort. It should be encouraged and proposed to patients during elective caesarean section. It will be interesting to evaluate it in case of caesarean section during labor.

Factors related to impaired comfort in chronic kidney disease patients on hemodialysis / Factores relacionados con la comodidad perjudicada en pacientes renales crónicos hemodialíticos / Fatores relacionados ao conforto prejudicado em pacientes renais crônicos hemodialíticos

ABSTRACT Objective: to analyze the factors related to the impaired comfort of chronic kidney diseases (CKD) patients on hemodialysis. Method: this is a cross-sectional study with 80 patients undergoing hemodialysis in a renal replacement therapy unit through interviews using two instruments, one for clinical and sociodemographic characteristics and the General Comfort Questionnaire, during the hemodialysis session. Mann-Whitney tests and the logistic regression model were used for data analysis. Results: the study found that being younger (p=0.045); being married (p=0.05); and absence of impaired physical mobility (p=0.007) were contributing factors for greater comfort in CKD patients on hemodialysis. Thus, when establishing the odds ratio, it was possible to observe that being 55 years of age or older, being single and having impaired physical mobility represents a 45.7% chance of developing this diagnosis. Conclusions: sociodemographic and clinical variables contribute to the study outcome, demanding attention during the planning of nursing interventions.

RESUMEN Objetivo: valorar los factores relacionados con la comodidad perjudicada del paciente renal crónico hemodialítico. Método: estudio transversal en el cual se entrevistaron 80 pacientes bajo tratamiento hemodialítico en una unidad de terapia renal sustitutiva, siendo aplicados dos instrumentos, las características sociodemográficas clínicas de salud y la Escala Comfort General, durante la sesión de hemodiálisis. Se utilizaron el test de Mann-Whitney y el modelo de regresión logística en el análisis de datos. Resultados: se observó que los factores que contribuyeron a una mayor sensación de comodidad en los pacientes renales crónicos hemodialíticos fueron: ser más joven (p=0,045); estar casado (p=0,05); y no tener la movilidad física perjudicada (p=0,007). En este sentido, al establecer la odds ratio, se observó que tener edad igual a 55 años o más, estar soltero y presentar movilidad física perjudicada representa un 45,7% de probabilidad de desarrollar este diagnóstico. Conclusiones: las variables sociodemográficas y clínicas contribuyen al desenlace en estudio, requiriendo atención ante la planificación de las intervenciones de enfermería.

RESUMO Objetivo: analisar os fatores relacionados ao conforto prejudicado do paciente renal crônico hemodialítico. Método: estudo transversal com 80 pacientes sob tratamento hemodialítico em unidade de terapia renal substitutiva por meio de entrevista com aplicação de dois instrumentos, características sociodemográficas clínicas de saúde e Escala de Conforto Geral, durante sessão de hemodiálise. Utilizou-se os testes de Mann-Whitney e modelo de regressão logística para análise dos dados. Resultados: observou-se que ser mais jovem (p=0,045); estar casado (p=0,05); e ausência de mobilidade física prejudicada (p=0,007) foram fatores contribuintes para maior conforto nos pacientes renais crônicos hemodialíticos. Nesse sentido, ao estabelecer a odds ratio, foi possível observar que ter idade maior ou igual a 55 anos, estar solteiro e apresentar mobilidade física prejudicada representa 45,7% de chance de desenvolver esse diagnóstico. Conclusões: variáveis sociodemográficas e clínicas contribuem para o desfecho em estudo, requerendo atenção diante do planejamento das intervenções de enfermagem.

Evaluating the Pharmacological Management of Terminal Delirium in Imminently Dying Patients With and Without the Comfort Measure Order Set.

Terminal delirium is a distressing irreversible process that occurs frequently in the dying phase, often misdiagnosed and undertreated. A previous study in our organization revealed that terminal delirium was a poorly managed symptom at end of life. Pharmacological options are available in an existing order set to manage this symptom. The management plans of 41 patients identified as having terminal delirium were further evaluated. Elements extracted included medications prescribed to manage terminal delirium, whether medication changes occurred, and whether they were administered and effective. Patients with the order set were more comfortable as compared with the group without. Both groups had several changes made by the palliative care team. Nurses did not administer prescribed as-needed medication to more than one-third of patients. Modifications will be made to the existing order set, and additional education for staff will be organized.

A new tool to assess patients' comfort during hospitalization: The Hospital Discomfort Risk questionnaire.

AIM: We aimed to develop a tool for the assessment of the risk of patient discomfort in Spanish hospital wards. BACKGROUND: Several studies described tools to assess comfort but most are long and complex. METHODS: Cross-sectional study performed in three phases ((a) initial design; (b) refinement and psychometric testing; and (c) internal validation of the Hospital Discomfort Risk [HDR] questionnaire). RESULTS: A voluntary expert panel proposed the HDR questionnaire. Internal consistency and factorial analysis were investigated in 270 (53.7% men, mean age 57.33 ± 18.7 years) inpatients. Based on the Cronbach's α, three items were removed to the final 8-item version of the questionnaire. The HDR questionnaire showed a good predictive ability for identifying the risk of discomfort (c-index: .897, 95% CI 0.854-0.930; p < .001). CONCLUSIONS: The HDR questionnaire could be useful for identifying inpatients at risk of discomfort, but further prospective studies should externally validate these results. IMPLICATIONS IN NURSING MANAGEMENT: Nurses are the healthcare professionals with better access to patients and the first in identifying complications of hospitalization. Patients' discomfort could be routinely assessed during hospitalizations using the HDR questionnaire. Nurse managers should play an important role in this accomplishment, by promoting its use and knowledge among the nurse staff.

Perceived Discomfort, Pain and Nonpain Symptoms in a Postanesthesia Care Unit: An Observational Study.

PURPOSE: To assess patient-perceived discomfort in a postanesthesia care unit (PACU) and to explore the contributing symptoms and related characteristics. DESIGN: Cross-sectional observation was used in this study. METHODS: Postgeneral anesthesia patients in a PACU were asked to report their overall discomfort level on a 0 to 10 scale and to report and rank the symptoms they were suffering. All data were analyzed with SPSS software. FINDINGS: The average level of perceived discomfort was 4.90 ± 2.669. A hierarchical regression model showed that pain and nonpain symptoms contributed 0.084 and 0.074 to the overall discomfort level, respectively. Dry mouth, sore throat, and urethral catheter discomfort were the most common nonpain symptoms. Sex, department, anesthesia duration, American Society of Anesthesiologists physical status classification and other symptoms were all related to symptom reports. CONCLUSIONS: PACU patients suffer medium levels of discomfort, with pain and nonpain symptoms contributing nearly equally to it. In addition, multiple related characteristics were identified.

Pruebas genéticas de venta directa a los consumidores. Perspectiva de la Comisión de Ética de la Asociación Española de Genética Humana / Directed to consumer genetic testing. Perspective from the Ethics commission of the Spanish Society for Human Genetics

No disponible

More than pills: alternative adjunct therapies to improve comfort in hospitalised patients.

Discomfort in the hospitalised patient continues to be one of the healthcare system's greatest challenges to positive patient outcomes. The patients' ability to focus on healing is impaired by discomforts such as pain, nausea and anxiety. Alternative, non-pharmacological therapies have shown to be effective in reducing discomfort and managing pain, complementing analgesic agents and optimising pain therapy modalities. This multi-cycle project is aimed to assess the effect of alternative therapies on inpatient, progressive care patients who reported discomfort or little to no relief in discomfort from prescribed analgesics and adjuvant agents. In the first Plan Do Study Act (PDSA) cycle, patients who reported discomfort were offered aromatherapy or visual relaxation DVDs. In the second PDSA cycle, patients were offered a comfort menu that consisted of multiple alternative interventions such as aromatherapy, ice or heat and ambulation. During each cycle, participants completed a survey measuring comfort levels before and after patient-selected alternative intervention(s) were administered. In the first PDSA cycle, 88% of patients reported an increase in comfort level after the intervention, and 97% reported an interest in using alternative therapy again. In the second PDSA cycle, 47% reported increased comfort, and 89% indicated a willingness to try alternative therapies again for improvement of comfort level. Overall, the quality improvement project increased the level of comfort reported by hospitalised patients, creating a gateway to comfort with less emphasis on prescribed analgesic medications.